Azeem Bazil, Fatima Yumna, Magsi Iffat Ambreen, Sheikh Hamza Ali Hasnain, Qasim Muhammad, Naveed Muhammad Abdullah, Asim Rabia, Azeem Muhammad Basit, Muhammad Tazheen Saleh, Doggar Mata-E-Alla, Imran Junaid, Hassan Ibrahim Nagmeldin, Ashraf Hamza
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
BMC Cardiovasc Disord. 2025 Aug 2;25(1):565. doi: 10.1186/s12872-025-05049-0.
Older adults with chronic kidney disease (CKD) experience disproportionately high mortality after acute myocardial infarction (AMI). Contemporary national trends-and their variation across demographic and geographic strata remain poorly defined.
Using the CDC WONDER Multiple Cause-of-Death files, we identified U.S. decedents ≥ 65 years in whom ICD-10 codes for AMI and renal failure appeared anywhere on the death certificate between 1999 and 2023. Age-adjusted mortality rates (AAMRS) per 100,000 population were standardized to the 2000 U.S. census. Joinpoint regression quantified annual per cent change (APC) and inflexion points overall and by sex, race/ethnicity, census region, state, and urban-rural status.
Among 288,801 AMI-related renal-failure deaths, the AAMR fell from 42.1 in 1999 to 18.5 in 2023. Mortality declined steadily from 1999-2012 (APC - 3.39%; 95% CI - 4.25 to - 1.16) and more sharply from 2012-2015 (APC - 17.82%; 95% CI - 22.98 to - 6.99), but rose thereafter (2015-2023 APC + 3.01%; 95% CI - 0.21 to 16.30). Men carried persistently higher rates than women (overall AAMR 39.2 vs 21.2). Non-Hispanic Black adults had the greatest burden (AAMR 35.8), followed by non-Hispanic American Indian/Alaska Native (34.7) and Asian/Pacific Islander patients (34.2); non-Hispanic White adults had the lowest (26.4). From 2020-2023, AAMRs rebounded across most groups and surged 85% among Asian/Pacific Islanders. Regionally, the South recorded the highest AAMR (28.8), and state-level rates ranged three-fold (Utah 14.5 to Rhode Island 43.0). Non-metropolitan counties consistently exceeded metropolitan areas (34.5 vs 28.1).
Two decades of improvement in AMI mortality among older adults with renal failure have stalled, with a worrisome upturn since 2015 and widening disparities by sex, race, geography, and rurality. These findings underscore the need for cardiovascular-kidney-metabolic-focused prevention, equitable access to acute cardiac care, and tailored post-AMI management to avert further excess deaths in this growing high-risk population.
患有慢性肾脏病（CKD）的老年人在急性心肌梗死（AMI）后死亡率高得不成比例。当代全国趋势及其在人口和地理层面的差异仍不清楚。
利用美国疾病控制与预防中心（CDC）的多死因数据库，我们确定了1999年至2023年间死亡证明上任何位置出现AMI和肾衰竭ICD-10编码的65岁及以上美国死者。每10万人口的年龄调整死亡率（AAMR）根据2000年美国人口普查进行标准化。Joinpoint回归量化了总体以及按性别、种族/族裔、人口普查区域、州和城乡地位划分的年度变化百分比（APC）和转折点。
在288,801例与AMI相关的肾衰竭死亡病例中，AAMR从1999年的42.1降至2023年的18.5。死亡率从1999年至2012年稳步下降（APC -3.39%；95%CI -4.25至-1.16），2012年至2015年下降更为明显（APC -17.82%；95%CI -22.98至-6.99），但此后上升（2015年至2023年APC +3.01%；95%CI -0.21至16.30）。男性的死亡率一直高于女性（总体AAMR 39.2对21.2）。非西班牙裔黑人成年人负担最重（AAMR 35.8），其次是非西班牙裔美国印第安人/阿拉斯加原住民（34.7）和亚太岛民患者（34.2）；非西班牙裔白人成年人负担最轻（26.4）。从2020年至2023年，大多数群体的AAMR出现反弹，亚太岛民中激增85%。在地区方面，南部的AAMR最高（28.8），州一级的比率相差三倍（犹他州14.5至罗德岛州43.0）。非大都市县的死亡率一直超过大都市地区（34.5对28.1）。
肾衰竭老年人AMI死亡率二十年的改善已停滞，自2015年以来出现令人担忧的上升，且在性别、种族、地理和农村地区方面的差距不断扩大。这些发现强调需要以心血管-肾脏-代谢为重点的预防、公平获得急性心脏护理以及针对AMI后的定制管理，以避免在这一不断增长的高危人群中进一步出现过多死亡。
